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252 UNIT III Nursing Conceptual Models

knowledge in the stages of theory development. Orem a body of knowledge. The efforts of nurse scholars
presented a visionary view of contemporary nursing and nurse researchers to build on this foundation will
practice, education, and knowledge development ex- result in a body of knowledge that serves nurses in
pressed through the general theory. their provision of care to persons requiring nursing.

Summary CASE STUDY
The critical question—What is the condition that in- Theory of Dependent-Care
dicates that a person needs nursing care?—was the
starting point for the development of the SCDNT. This case study documents an ongoing interaction
Orem noted that it was the inability of persons to between a wife and her husband who live in a spa-
maintain on a continuous basis their own care or the cious home in a gated community.
care of dependents. From this observation, she began When Dan (now 80) and Jane (now 65) began
the process of formalizing knowledge about what dating over 15 years ago, both were emotionally
persons need to do or have done for themselves to charged to begin their lives anew. Well-educated
maintain health and well-being. When a person needs and financially secure, they had a lot in common.
assistance, what are the appropriate nursing assistive Dan was a protestant minister, and Jane’s deceased
actions? The theory of self-care describes what a husband had been a protestant minister. Both had
person requires and what actions need to be taken to lost their spouses. Jane’s first husband had suffered
meet those requirements. The theory of dependent- a catastrophic cerebral aneurysm 2 years earlier.
care is complex. It parallels Orem’s theory of self-care. Oddly enough, Dan had conducted the funeral
The theory of self-care deficits describes the limita- service for Jane’s husband. Dan’s wife had died of
tions involved in meeting requirements for ongoing terminal cancer a little over a year earlier. Dan’s
care and the effects they have on the health and well- first wife had been a school counselor; Jane was a
being of the person or dependent. The theory of nurs- school teacher. Both had children in college. They
ing systems provides the structure for examining shared a love for travel. Dan was retired but con-
the actions and antecedent knowledge required to tinued part-time employment, and Jane planned
assist the person. These theories also are descriptive to continue teaching in order to qualify for retire-
of situations involving families and communities. ment. Both were in great health and had more
Orem’s work related to nursing as a practical sci- than adequate health benefits. Within the year
ence and the identification of three practice sciences they were married. Summer vacations were spent
and three foundational nursing sciences provides snorkeling in Hawaii, mountain climbing in na-
direction for the development of nursing science. This tional parks, and boating with family. Their lives
work offers a structure for the organization of existing were full and productive. After 7 years, Dan expe-
nursing knowledge, as well as for the generation of rienced major health problems: a quadruple
new knowledge. cardiac bypass surgery, followed by surgery for
In an interview with Jacqueline Fawcett (2001), pancreatic cancer. Jane’s plans to continue working
Orem identified factors essential for the development were dropped so she could assist Dan to recover
of nursing science. They included the following: (1) a and then continue to travel with him and enjoy
model of practice science, (2) a valid, reliable, general their remaining time together. Dan did recover—
theory of nursing, (3) models of the operations of only to begin to exhibit the early signs and symp-
nursing practice, (4) development of the conceptual toms of Alzheimer’s disease. One of the early signs
structure of the general theory, and (5) integration of appeared the previous Christmas as they were
the conceptual elements of the theory with the prac- hanging outdoor lights. To Jane’s dismay, she noted
tice operations (p. 36). Orem’s work related to the that Dan could not follow the sequential direc-
SCDNT and the form of nursing science as a practical tions she gave him. As time passed, other signs
science provides a foundation for the development of appeared, such as some memory loss and confusion,